Sibel Saya1,2, Jennifer G McIntosh3,4,5, Ingrid M Winship6,7, Mark Clendenning3,8, Shakira Milton3,4, Jasmeen Oberoi3,4, James G Dowty9, Daniel D Buchanan3,7,8, Mark A Jenkins3,9, Jon D Emery3,4,10. 1. Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia, sibel.saya@unimelb.edu.au. 2. Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia, sibel.saya@unimelb.edu.au. 3. Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia. 4. Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia. 5. Department of Software Systems & Cybersecurity, Monash University, Melbourne, Victoria, Australia. 6. Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia. 7. Genomic Medicine & Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, Victoria, Australia. 8. Colorectal Oncogenomics Group, Department of Clinical Pathology, The University of Melbourne, Melbourne, Victoria, Australia. 9. Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia. 10. The Primary Care Unit, University of Cambridge, Cambridge, United Kingdom.
Abstract
INTRODUCTION: Genomic tests can predict risk and tailor screening recommendations for colorectal cancer (CRC). Primary care could be suitable for their widespread implementation. OBJECTIVE: We aimed to assess the feasibility and acceptability of administering a CRC genomic test in primary care. METHODS: Participants aged 45-74 years recruited from 4 Australian general practices were offered a genomic CRC risk test. Participants received brief verbal information about the test comprising 45 CRC-associated single-nucleotide polymorphisms, before choosing whether to undertake the test. Personalized risks were given to testers. Uptake and knowledge of the genomic test, cancer-specific anxiety (Cancer Worry Scale), psychosocial impact (Multidimensional Impact of Cancer Risk Assessment [MICRA] score), and impact on CRC screening behaviour within 6 months were measured. RESULTS: In 150 participants, test uptake was high (126, 84%), with 125 (83%) having good knowledge of the genomic test. Moderate risk participants were impacted more by the test (MICRA mean: 15.9) than average risk participants (mean: 9.5, difference in means: 6.4, 95% confidence interval (CI): 1.5, 11.2, p = 0.01), but all scores were low. Average risk participants' cancer-specific anxiety decreased (mean differences from baseline: 1 month -0.5, 95% CI: -1.0, -0.1, p = 0.03; 6 months -0.6, 95% CI: -1.0, -0.2, p = 0.01). We found limited evidence for genomic testers being more likely to complete the risk-appropriate CRC screening than non-testers (41 vs. 17%, odds ratio = 3.4, 95% CI: 0.6, 34.8, p = 0.19), but some mediators of screening behaviour were altered in genomic testers. CONCLUSIONS: Genomic testing for CRC risk in primary care is acceptable and likely feasible. Further development of the risk assessment intervention could strengthen the impact on screening behaviour.
INTRODUCTION: Genomic tests can predict risk and tailor screening recommendations for colorectal cancer (CRC). Primary care could be suitable for their widespread implementation. OBJECTIVE: We aimed to assess the feasibility and acceptability of administering a CRC genomic test in primary care. METHODS:Participants aged 45-74 years recruited from 4 Australian general practices were offered a genomic CRC risk test. Participants received brief verbal information about the test comprising 45 CRC-associated single-nucleotide polymorphisms, before choosing whether to undertake the test. Personalized risks were given to testers. Uptake and knowledge of the genomic test, cancer-specific anxiety (Cancer Worry Scale), psychosocial impact (Multidimensional Impact of Cancer Risk Assessment [MICRA] score), and impact on CRC screening behaviour within 6 months were measured. RESULTS: In 150 participants, test uptake was high (126, 84%), with 125 (83%) having good knowledge of the genomic test. Moderate risk participants were impacted more by the test (MICRA mean: 15.9) than average risk participants (mean: 9.5, difference in means: 6.4, 95% confidence interval (CI): 1.5, 11.2, p = 0.01), but all scores were low. Average risk participants' cancer-specific anxiety decreased (mean differences from baseline: 1 month -0.5, 95% CI: -1.0, -0.1, p = 0.03; 6 months -0.6, 95% CI: -1.0, -0.2, p = 0.01). We found limited evidence for genomic testers being more likely to complete the risk-appropriate CRC screening than non-testers (41 vs. 17%, odds ratio = 3.4, 95% CI: 0.6, 34.8, p = 0.19), but some mediators of screening behaviour were altered in genomic testers. CONCLUSIONS: Genomic testing for CRC risk in primary care is acceptable and likely feasible. Further development of the risk assessment intervention could strengthen the impact on screening behaviour.
Authors: Sibel Saya; Lucy Boyd; Patty Chondros; Mairead McNamara; Michelle King; Shakira Milton; Richard De Abreu Lourenco; Malcolm Clark; George Fishman; Julie Marker; Cheri Ostroff; Richard Allman; Fiona M Walter; Daniel Buchanan; Ingrid Winship; Jennifer McIntosh; Finlay Macrae; Mark Jenkins; Jon Emery Journal: Trials Date: 2022-09-27 Impact factor: 2.728